Flatø B, Sørskaar D, Vinje O, Lien G, Aasland A, Moum T, Førre O
Center for Rheumatic Diseases, the National Hospital, OSR, University of Oslo, Norway.
J Rheumatol. 1998 Sep;25(9):1851-8.
To assess the reliability, validity, and sensitivity to change of the Norwegian version of the childhood Health Assessment Questionnaire (CHAQ) and to examine the relationship between disability, disease severity, and psychosocial factors in patients with early juvenile rheumatoid arthritis (JRA).
Physical functioning was assessed by the CHAQ in 109 patients (median age 6.6 years, range 1.0-16.6) with JRA and a median of 4 months' (range 2-23) disease duration. Eighty-three patients were reassessed after a median of 6 months (range 3-21). Psychosocial functioning was assessed by the Child Behavior Checklist (n=39).
The internal consistency of the CHAQ was good (Cronbach's alpha=0.83). The test-retest and parent-patient correlations were high [intraclass correlation coefficients 0.85 (n=18) and 0.75 (n=20), respectively, p < 0.001]. The CHAQ correlated moderately with number of tender, swollen and mobility restricted joints, morning stiffness, C-reactive protein, pain, and patients' and physicians' global assessments [correlation coefficients (r) ranging from 0.55 to 0.30, p < 0.01], but weakly with erythrocyte sedimentation rate (r=0.17, NS). The CHAQ also correlated with low levels of social competence (r=-0.49, p < 0.05) and high levels of internalizing behavior problems in the patients (r=0.43, p < 0.01) and low education levels of the mothers (r=-0.31, p < 0.01). Pain (beta 0.45, p < 0.001), number of swollen joints (beta 0.31, p < 0.001), and internalizing behavior problems (beta 0.45, p < 0.01) were predictors of disability. The median CHAQ changed from 0.25 to 0.00 (p < 0.05) in the 41 patients who improved, from 0.31 to 0.85 (p < 0.05) in the 18 patients whose condition was worse, and from 0.50 to 0.59 (NS) in the 24 patients whose condition was unchanged after 6 months. The effect size of the change was small (0.28) in those who improved and moderate (0.54) in those who became worse.
The Norwegian version of the CHAQ is a reliable and valid instrument for measuring disability in children with early JRA. Pain, joint inflammation, and psychosocial factors are the most important correlates of disability and the CHAQ is sensitive to clinical change.
评估挪威版儿童健康评估问卷（CHAQ）的信度、效度及对变化的敏感性，并研究幼年类风湿关节炎（JRA）早期患者的残疾、疾病严重程度与心理社会因素之间的关系。
采用CHAQ对109例JRA患者（中位年龄6.6岁，范围1.0 - 16.6岁）的身体功能进行评估，疾病持续时间中位数为4个月（范围2 - 23个月）。83例患者在中位数为6个月（范围3 - 21个月）后进行了重新评估。采用儿童行为量表对心理社会功能进行评估（n = 39）。
CHAQ的内部一致性良好（Cronbach's α = 0.83）。重测信度和家长 - 患者相关性较高[组内相关系数分别为0.85（n = 18）和0.75（n = 20），p < 0.001]。CHAQ与压痛关节数、肿胀关节数、活动受限关节数、晨僵、C反应蛋白、疼痛以及患者和医生的整体评估呈中度相关[相关系数（r）范围为0.55至0.30，p < 0.01]，但与红细胞沉降率呈弱相关（r = 0.17，无统计学意义）。CHAQ还与患者的低社会能力水平（r = -0.49，p < 0.05）、高内化行为问题水平（r = 0.43，p < 0.01）以及母亲的低教育水平（r = -0.得0.31，p < 0.01）相关。疼痛（β = 0.45，p < 0.001）、肿胀关节数（β = 0.31，p < 0.001）和内化行为问题（β = 0.45，p < 0.01）是残疾的预测因素。41例病情改善的患者CHAQ中位数从0.25变为0.00（p < 0.05），18例病情恶化的患者从0.31变为0.85（p < 0.05），24例病情6个月后未改变的患者从0.50变为0.59（无统计学意义）。改善患者的变化效应大小较小（0.28），恶化患者的变化效应大小为中等（0.54）。
挪威版CHAQ是测量JRA早期儿童残疾的可靠有效工具。疼痛、关节炎症和心理社会因素是残疾最重要的相关因素，且CHAQ对临床变化敏感。
